Intolerance to Enteral Nutrition

OVERVIEW

• Intolerance to enteral nutrition is characterised by excessive aspirates (>500mL q6h),vomiting, abdominal distension, constipation or diarrhoea

CAUSES

Patient

• GORD
• hiatus hernia
• gastroparesis/ileus
• pseudo-obstruction
• retroperitoneal haematoma/oedema
• bowel injury
• bowel ischaemia
• shock
• sepsis
• pancreatitis
• bowel obstruction
• hyperglycemia
• hypoxia / ischemia
• trauma
• burns

Mechanical

• NGT not placed in stomach
• kinking
• blockage

Drugs

• opioids
• sedation
• no prokinetics
• hyperosmolar formulas

ASSESSMENT

History

• sedation/analgesia: hold?
• history of symptoms
• discussion with surgeon
• search for sepsis, pancreatitis, MI, GI pathology, cause of shock

Examination

• to find above pathologies

Investigations

• AXR
• CXR (erect)
• CT abdomen

MANAGEMENT

General approach

• rule out bowel obstruction
• minimize drugs causing gastroparesis or ileus
• correct electrolytes
• start at low volumes with steady increases until goal rate achieved
• prokinetics
• consider NJ feeding
• TPN

Approach to gastric residual volumes >500mL q6h

• see Gastric Residual Volume

References and Links

LITFL

• CCC — Prokinetics
• CCC — Gastric Residual Volume

Journal articles

• Deane A, Chapman MJ, Fraser RJ, Bryant LK, Burgstad C, Nguyen NQ. Mechanisms underlying feed intolerance in the critically ill: implications for treatment. World J Gastroenterol. 2007 Aug 7;13(29):3909-17. PMID: 17663503.